Job description:

NOTE:

Health Insurance covered 100% including family coverage. Fully remote after in office paid training Medical Claims Examiner Position Overview We are seeking a detail-oriented and analytical Medical Claims Examiner to join our healthcare administration team. The ideal candidate will be responsible for reviewing, evaluating, and processing medical insurance claims to ensure accuracy, compliance, and timely reimbursement. This role plays a critical part in maintaining the integrity of our claims process and ensuring fair outcomes for providers and patients. Key Responsibilities Claims Review & Evaluation Examine medical claims for completeness, accuracy, and compliance with policy guidelines. Verify patient eligibility, coverage limits, and provider credentials. Assess medical necessity and appropriateness of procedures and treatments. Documentation & Analysis Interpret medical records, billing codes (ICD-10, CPT, HCPCS), and insurance policies. Identify discrepancies, fraudulent claims, or billing errors. Request additional documentation or clarification from providers when needed. Communication & Coordination Collaborate with healthcare providers, insurance agents, and internal departments. Communicate claim decisions clearly and professionally to stakeholders. Provide guidance on claim appeals and resolution processes. Compliance & Reporting Ensure adherence to federal and state regulations (e.g., HIPAA, CMS guidelines). Maintain accurate records and generate reports on claim status and trends. Stay updated on changes in medical coding, insurance regulations, and industry standards. Qualifications Certification in medical coding or claims processing (e.g., CPC, CPMA) is a plus. 2+ years of experience in medical claims examination or healthcare billing. Strong knowledge of medical terminology, coding systems, and insurance procedures. Excellent analytical, organizational, and communication skills. Proficiency in claims management software and Microsoft Office Suite. Work Environment Full-time position with flexible remote or hybrid options. Fast-paced, deadline-driven environment. Opportunities for professional development and advancement.

Pay:

$26.00 - $30.00 per hour Expected hours: 35.0 per week

Benefits:

401(k) Health insurance Health savings account Life insurance Paid time off Parental leave Vision insurance

Work Location:

Hybrid remote in Garden City, NY 11531